UNIVERSITY OF WISCONSIN MEDICAL SCHOOL

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Faculty members are required to notify their departments in advance of absences that will take them away from their “classes or other regular ... UW Medical School
UNIVERSITY OF WISCONSIN MEDICAL SCHOOL “FACULTY” ABSENCE REPORTING FORM 11/00

Faculty members are required to notify their departments in advance of absences that will take them away from their “classes or other regular duties at the University.” Faculty Policies and Procedures require that prior permission be received from the chancellor or the dean. The Medical School Dean has delegated the responsibility for approval of absences to the departmental Chairs. For purposes of accountability to the University and the State, it is important that all faculty members file the following form with the department Chair in advance of foreseeable absences. Obviously, absences caused by illness or mishap can only be reported retrospectively.

Dates of anticipated absence:

Reason of absence: ( Vacation ( Present seminar or attend professional meeting ( Professional service (Service as officer of a professional society, member of a study section, etc.) ( Outside activity related to university duties (I.e., consulting)

General description of activity:

If the absence will be partly business and partly vacation, how many days will be counted as vacation?

While you are away, who will cover your

Teaching duties? Research duties? Clinical duties? Administrative duties?

How can you be reached while you are away?

Name (printed): Signature: Date:

Please send this form to the Chair of your department at least 10 working days prior to the anticipated absence. The Chair will respond within 5 days if the absence is not approved.

Chair’s signature: Date:

The Chairs form should be sent to the Dean’s Office for approval.

Dean’s Signature: Date:

”Faculty” refers to all tenure track and paid collateral faculty

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